Retrosternal thyroid surgery

The thyroid gland is normally located at the front of the neck. A retrosternal thyroid refers to the abnormallocation of all or part of the thyroid gland below the breastbone (sternum).

This article discusses surgery for aretrosternal thyroid.

Alternative Names

Substernalthyroid - surgery; Mediastinal goiter - surgery

Description

Aretrosternal goiteris always a consideration in patients who have a mass sticking out of the neck.Aretrosternal goiter usually causes no symptoms for years.It is oftendetected when a chest x-ray is done for another reason. Any symptoms are usually due to pressure on nearbystructures, such asthe trachea and esophagus.

Surgery to completely remove the goiter isrecommended, even if you do not have symptoms.

During the surgery:

You receive general anesthesia. This makes you unconscious and unable to feel pain.

Youlie on your back with your neck slightly extended.

The surgeon makes a 3 to 4 inch surgical cut (incision) inyour neck to determine if the mass can be removed without opening the chest. Most of the time, the surgery can be done this way.

If the mass is deep inside the chest, the surgeon makes anincision along the middle of your chest bone.The entiregoiteris thenremoved. A tube may be left in placeto drain fluid and blood. It is usually removed in 1 to 2 days.

Why the Procedure is Performed

Thissurgery is done to completely remove the mass. If it is not removed, it can put pressure on your airways and food tube (esophagus).

If the retrosternal goiter has been there for a long time, youcan have difficulty swallowing food,mild pain in the neck area, and shortness of breath.

If your doctor thinks you have a retrosternal thyroid, you will have the following tests done before anysurgery:

Blood calcium test

CT or MRI scan of the neck and chest

Thyroid function tests

Barium swallow test to check your esophagus

Lung function tests to check for airway blockage

Risks

Risks of anesthesia are:

Allergic reactions to medicines

Breathing problems

Risks of retrosternal thyroid surgery are:

Bleeding

Damage to parathyroid glands, resulting in low calcium

Damage to trachea

Perforation of esophagus

Vocal cord paralysis

Wound infection

Before the Procedure

You may need to have tests that show exactly where your thyroid gland is located. This will help the surgeon find the growth during surgery. You may have a CT scan, ultrasound, or other imaging tests.

You may also need thyroid medicine or iodine treatments 1 to 2 weeks before surgery.

Tell your doctor or nurse about all the medicines you take, even those bought without a prescription. This includes herbs and supplements.

Several days to a week before surgery, you may be asked to stop taking medicines that make it harder for your blood to clot. These include:

Aspirin

Clopidogrel (Plavix)

Ibuprofen (Advil, Motrin)

Naproxen (Aleve, Naprosyn)

Warfarin (Coumadin)

You will probably be asked to stop eating or drinking at some point the night before or day of surgery. Your doctor or nurse will give you specific instructions.

Ask your doctor which medicines you should still take the day of surgery.

If you smoke, try to stop. Your recovery time will be shorter if you do not smoke. Ask your doctor or nurse for help.

Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

You may have a drain in your neck after surgery. It will drain fluid that builds up in the area. It will be removed within a day or so.

You may need to stay in the hospital overnight after surgery so a nurse can watch for any bleeding, change in calcium level, or breathing problems.

You may go home the next day if the surgery was done through the neck. If the chest was opened up, you may stay in hospital for several days.

Most patients are able to get up and walk on the day after surgery. It should take about 3 to 4 weeks for you to fully recover.

You may have pain after surgery. Ask your doctor or nurse for instructions on how to take medicines after you go home.

Follow any instructions for taking care of yourself after you go home.

Outlook (Prognosis)

A patient usually does well after the retrosternal thyroid is removed. It does not usually return. Adding iodized salt to your meals can help prevent a recurrence.